MEDICARE: LISA MARIE DUTZMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1144152216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE DUTZMAN

Provider Business Mailing Address
First Line	:	3116 WATERSIDE LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-2132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3116 WATERSIDE LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-2132
Country	:	US
Telephone Number	:	703-269-8975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ LISA MARIE DUTZMAN ” Practice Location

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